Fracture of Contemporary Femoral Stems: Common Trends in This Rare Occurrence.

Background: Fracture of contemporary femoral stems is a rare occurrence in total hip arthroplasty. A knowledge gap remains regarding manufacturing, patient, and surgeon factors that may contribute to the increased risk of this complication.

Methods: We analyzed 13 contemporary fractured porous-coated femoral stems of various designs to determine cause and contributing factors of mechanical failure.

Robotic-assisted total hip arthroplasty: an economic analysis.

To evaluate 90-day episode-of-care (EOC) resource consumption in robotic-assisted total hip arthroplasty (RATHA) versus manual total hip arthroplasty (mTHA). THA procedures were identified in Medicare 100% data. After propensity score matching 1:5, 938 RATHA and 4,670 mTHA cases were included.

Robotic arm-assisted knee surgery: an economic analysis.

Objectives: Previous studies on Medicare populations have shown improved outcomes and decreased 90-day episode-of-care costs with robotic arm-assisted total knee arthroplasty (RATKA). The purpose of this study was to evaluate expenditures and utilization following RATKA in the population younger than 65 years.

Study Design: This is a retrospective longitudinal analysis of a commercial claims data set.

The Current Status of Cell-Based Therapies for Primary Knee Osteoarthritis.

There is a growing interest in cell therapy for knee osteoarthritis. This study systematically reviews the current status of cell-based therapies. The authors review treatment modalities, clinical outcomes, and the economics of cell therapy.

Stem Cells and Platelet-rich Plasma for Knee Osteoarthritis: Prevalence and Cost in South Florida.

Introduction: The use of stem cell therapy (SCT) and platelet-rich plasma (PRP) injection for knee osteoarthritis (OA) is extremely controversial and at best experimental stage. These treatments are being offered across the nation for "cash-only payments." Our objectives were to determine (1) what proportion of board-certified orthopedic surgeons in Miami-Dade County offer SCT or PRP and (2) how much do practices charge for these services.

Rehabilitation Outcomes for Total Knee Arthroplasties: Continuous Adductor Canal Block Versus Continuous Femoral Nerve Block.

Objective: To determine whether any strength, range of motion (ROM), or functional improvement exists in the adductor canal block (ACB) group after completion of inpatient rehabilitation and following the removal of the continuous block.

Design: Retrospective cohort.

Setting: Inpatient rehabilitation at discharge and outpatient orthopedic clinic for follow-up.

Primary Total Knee Arthroplasty: How Does Residual Patellar Thickness Affect Patient-Oriented Outcomes?

Background: Maintenance of the native patellar thickness has been deemed important for proper clinical outcomes after total knee arthroplasty (TKA). Our objective was to study the effects of the change in patellar thickness on patient-perceived outcomes (PPOs) after TKA. We hypothesized that reestablishing native patellar thickness after TKA results in better PPOs.

Cultural Biases in Current Medical Practices with a Specific Attention to Orthopedic Surgery: a Review.

Due to the increasing diversity within the United States population, there is an ever-increasing need for increased education on cultural literacy and tolerance in medical schools and residency programs. The purpose of this article was to review how a person's culture can play a substantive role in effecting and influencing (1) medical diagnosis, (2) patient and health provider medical decision-making, (3) the patient's perception of disease, and (4) the doctor-patient relationships. Many of the decisions we make as orthopedic surgeons must account for the patient's cultural needs, as much of our work impacts patients' daily activities and function.

Prolonged Conservative Management in Total Joint Arthroplasty: Harming the Patient?

Background: It is important to understand the long-term consequences of postponing total joint arthroplasty until the onset of severe functional impairment. Therefore, the purpose of this investigation was to determine and compare the midterm to long-term postoperative outcomes of patients who underwent total joint arthroplasty with severe vs less severe preoperative functional impairment.

Methods: A total of 105 primary unilateral total hip/knee arthroplasty patients were studied.

Preoperative Glycemic Control on Total Joint Arthroplasty Patient-Perceived Outcomes and Hospital Costs.

Background: The purpose of this study was to determine the influence of preoperative glycemic control in diabetic patients undergoing a primary total hip or knee arthroplasty. We wanted to study patient-perceived outcomes in the medium term, the length of stay, hospital costs, and rate of short-term postoperative complications.

Methods: One hundred twenty consecutive primary total joint arthroplasties (TJAs) performed in type 2 diabetic patients were stratified into 2 groups representing optimal and suboptimal preoperative glycemic control, based on serum levels of glycated hemoglobin (HbA), and those groups compared.

Total Joint Arthroplasty: A Granular Analysis of Outcomes in the Economically Disadvantaged Patient.

Background: Poor patients experience more serious complications and worse outcomes after surgery than higher-income patients. Our objective was to study detailed patient sociodemographic characteristics and preoperative/postoperative patient-oriented outcomes in economically disadvantaged and non-economically disadvantaged primary total joint arthroplasty patients.

Methods: From a consecutive series, 213 economically disadvantaged patients and 1940 non-economically-disadvantaged patients were statistically analyzed.

Update on Biomaterials.

Biomaterials are essential to the use and development of successful treatments for orthopaedic patients. Orthopaedic surgeons need to understand the expected clinical performance and the effects of implants in patients. Recent attempts to improve implant durability have resulted in adverse effects related to biomaterials and their relationship to patients.

Preventing Leg Length Discrepancy and Instability After Total Hip Arthroplasty.

Restoration of equal leg lengths and dynamic hip stability are essential elements of a successful total hip arthroplasty. A careful clinical examination, a preoperative plan, and appropriate intraoperative techniques are necessary to achieve these goals. Preoperative identification of patients at risk for residual leg length discrepancy allows surgeons to adjust the surgical approach and/or the type of implant and provide better preoperative patient education.

Bilateral atypical femoral fracture and end-stage arthritis of the hip, treated with total hip arthroplasty.

The prolonged use of bisphosphonates has been associated with an increased rate of atypical femoral fracture. A 77-year-old woman with prolonged bisphosphonate use presented to our office with groin pain and end-stage arthritis, She was scheduled for a total hip replacement. Before the surgery and with minimal trauma, the patient then suffered a displaced atypical femoral fracture.

Racial Disparities in Lower Extremity Arthroplasty Outcomes and Use.

Race-associated disparities often occur in patients who undergo lower extremity total joint arthroplasty (TJA). Although it is imperative to elucidate and describe the disparities in race and ethnicity that may influence patient perception, satisfaction, and surgical outcomes, there is a paucity of reports detailing the nature of potential racial disparities in TJA. Therefore, the purpose of this review was to examine racial and ethnic disparities in the (1) physician-patient relationship; (2) use of TJA; (3) intraoperative and 30-day postoperative complications; and (4) patient-reported outcomes.

Does Race Affect Outcomes in Total Joint Arthroplasty?

Background: Several studies suggest worse surgical outcomes among racial/ethnic minorities. There is a paucity of research on preoperative and postoperative pain, general health, and disease-specific measures in which race is the main subject of investigation; furthermore, the results are not conclusive.

Questions/purposes: (1) Do black patients have more severe or more frequent preoperative pain, well-being, general health, and disease-specific scores when compared with white patients? (2) Are there differences between black patients and white patients after hip or knee arthroplasty on those same measures?

Methods: In this retrospective study, we used an institutional arthroplasty registry to analyze data on 2010 primary arthroplasties (1446 knees and 564 hips) performed by one surgeon at a single institution.

High Rates of Interest in Sex in Patients With Hip Arthritis.

Background: Being sexually active has been associated with a high quality of life. Unfortunately, the topic of sexual limitations in patients undergoing total hip arthroplasty (THA) has not been well studied.

Question/purposes: (1) What proportion of patients experience sexual limitations because of hip arthritis before THA; (2) whether patient reports of sexual limitations would be associated with poorer results on general health and hip-specific instruments; and (3) whether patient reports of sexual limitations would be associated with poorer preoperative range of motion.

Total hip arthroplasty in the treatment of osteonecrosis of the femoral head: then and now.

The objective of this review is to summarize and analyze the survivorship and the reported results of the use of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head. In the past, THA was thought to have poor survivorship and poor clinical and radiological results in patients with this diagnosis. However, more recent reports have suggested an improvement in the survivorship, radiological results, and outcomes of THAs when performed for this condition.

A current review of core decompression in the treatment of osteonecrosis of the femoral head.

The review describes the following: (1) how traditional core decompression is performed, (2) adjunctive treatments, (3) multiple percutaneous drilling technique, and (4) the overall outcomes of these procedures. Core decompression has optimal outcomes when used in the earliest, precollapse disease stages. More recent studies have reported excellent outcomes with percutaneous drilling.

Readmission Rates in Total Hip Arthroplasty: A Granular Analysis?

A deeper understanding of readmissions in arthroplasty is warranted. We wanted to determine in primary THA patients: readmission rates; baseline characteristics of patients with/without readmissions; and readmission reasons. 201 consecutive patients were studied.

The Cost-Utility of Total Hip Arthroplasty: Earlier Intervention, Improved Economics.

We estimated the cost of Quality-Adjusted-Life-Years gained according to preoperative disease severity. We studied 159 primary unilateral THA, mean follow-up: 4 years. A median split of preoperative WOMAC scores was done to set apart a low (better) and a high (worse) score group.

Trunnion-Head Stresses in THA: Are Big Heads Trouble?

The effects of large heads on stresses at the THA trunnion-head junction and their impact on tribocorrosion/metal ion release remain controversial. A 12/14 3D-model of a stem with different head sizes was investigated. Material properties of titanium were assigned to the trunnion and cobalt-chrome/alumina to the heads.

Rapid recovery programs in arthroplasty: the money side.

The implementation of rapid recovery programs is the result of continuing efforts to achieve a shorter convalescing and faster "return-to-life" leading to higher quality and increased cost-effectiveness. The current traditional payment system stifles efficiency and the implementation of these programs. These payment systems incentivize "slowness" and longer lengths-of-stay.